Provider Demographics
NPI:1205875432
Name:MASSEY, GARY N (RPH)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:N
Last Name:MASSEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4071 DEER RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:NEOSHO
Mailing Address - State:MO
Mailing Address - Zip Code:64850-2900
Mailing Address - Country:US
Mailing Address - Phone:417-455-9193
Mailing Address - Fax:
Practice Address - Street 1:219 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NEOSHO
Practice Address - State:MO
Practice Address - Zip Code:64850-1818
Practice Address - Country:US
Practice Address - Phone:417-451-3775
Practice Address - Fax:417-455-3325
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO042988183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist